| NPI | 1093974040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 241269) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 241269) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD436995) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2014-10-17 |